Present status of ABO-incompatible living donor liver transplantation in japan
Present status of ABO-incompatible living donor liver transplantation in japan
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DOI：
10.1002/hep.21928
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发表时间：
2008-01-01
期刊：
影响因子：
13.5
通讯作者：
Shirnazu, Motohide
中科院分区：
文献类型：
--
作者：
Egawa, Hiroto;Teramukai, Satoshi;Shirnazu, Motohide
为了克服器官短缺，日本已经进行了abo血型不相容的活体肝移植（LDLT）。本文报道了2006年3月日本研究小组abo血型不相容移植国家登记处的结果。问卷包括患者特征、手术数据和预防抗体介导的排斥反应（AMR）的策略。收集28家医院291例患者资料，随访时间8个月~ 15年，平均35个月。年龄小于1岁者68例，1 ~ 7岁者60例，8 ~ 15岁者27例，16岁及以上者136例。血型屏障的策略在受者年龄、移植中心和时代方面是不同的。2000年和2003年分别采用局部输液和利妥昔单抗预防。婴儿5年生存率为85%，成人为52%。主要死亡原因是感染和抗体介导的排斥反应（AMR）。多因素分析显示，年龄、术前状况、抗体滴度和感染对生存率有显著影响。年龄、抗体滴度和局部输液治疗对AMR的发生率有显著影响。2000年以后，成人患者的生存率显著提高，AMR发生率显著降低（2000年5月、2000年6月至2003年10月和2003年11月的3年生存率分别为29%、56%和61%；AMR发生率分别为47%、27%和16%）。结论：abo血型不相容的LDLT是儿童的标准做法，成人的局部输液和利妥昔单抗预防是有希望的。
ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) has been performed in Japan to overcome the organ shortage. Reported herein are the results of this approach through March 2006 in the National Registry of the Japan Study Group for ABO-incompatible transplantation. The questionnaires consisted of patient characteristics, operative data, and strategies for preventing antibody-mediated rejection (AMR). Data of 291 patients (follow-up period, 8 months-15 years; mean, 35 months) from 28 institutions were collected. Age was younger than I year in 68 patients, 1 to 7 years in 60 patients, 8 to 15 years in 27 patients, and 16 years or older in 136 patients. The strategy for the blood-type barrier was heterogeneous in terms of recipient age, transplant center, and era. Local infusion and rituximab prophylaxis were applied in 2000 and 2003, respectively. The 5-year patient survival rate was 85% in infants and 52% in adults. The major causes of death were infection and antibody mediated rejection (AMR). Multivariate analysis showed that age group, preoperative condition, antibody titer, and infection significantly affected survival. Age group, antibody titer, and local infusion treatment significantly affected the incidence of AMR. Patient survival rates were significantly higher and the incidence of AMR was significantly lower in adult patients after 2000 (3 year-survival rate, 29%, 56%, and 61%; incidence of AMR, 47%,27%, and 16%, through May 2000, from June 2000 through October 2003, and from November 2003, respectively). Conclusion: ABO-incompatible LDLT is a standard practice in children, and local infusion and rituximab prophylaxis are promising in adults.